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Eye surgery and COVID: Do vaccines change the equation?

phoropter with eye mask during covid

If you need eye surgery, set up the appointment today. Don’t let COVID-19 change your mind. 

“There’s no eye surgery that would warrant a wait-and-see approach due to COVID-19,” said Brian Boxer Wachler, MD, an ophthalmologist and All About Vision contributor.

What about the arrival of COVID-19 vaccines? 

Boxer Wachler says standard COVID-19 safety protocols allow procedures like cataract surgery to go on as planned. Vaccines do not change that. 

“The surgery centers for cataract surgery practice high-level hygiene and safety, so people don’t need to worry about going there for cataract surgery without having the vaccine,” he said. “Some people might be psychologically more comfortable having the vaccine beforehand, though.”

Boxer Wachler is both confident that eye surgery is safe and emphatic that patients get the surgery they need — virus or no virus. This is especially true for emergencies such as retina tears and detachments, acute glaucoma and eye trauma. 

SEE RELATED: Should you have cataract surgery amidst COVID-19 concerns?

Vaccines are good news for patients and doctors

Across Boxer Wachler’s profession, ophthalmologists have had to pivot from calling off elective surgeries early in the pandemic to encouraging people not to delay eye surgeries. 

The shift has unfolded in the pages of the trade journal Ophthalmology Times, which has tracked the impact of the pandemic on patients and surgeons alike. Announcements of the first COVID vaccine approval in December 2020 was welcome news to the publication’s readers.  

“Because we have seen patients who have developed permanent vision loss due to a delay in care when the patients were afraid to come to their doctors’ offices earlier this year, it is important that we are able to help the population at risk for vision loss from retinal disease, glaucoma, etc., feel it is safe to see their ophthalmologist,” Peter J. McDonnell, MD, chief medical editor of Ophthalmology Times, said in a December 2020 article. McDonnell is director of the Wilmer Eye Institute at Johns Hopkins University School of Medicine in Baltimore. 

“The vaccine will be a major step in that direction for our patients, many of whom are at high risk due to their age, and diabetes,” he added. 

In the same article, ophthalmology professor William W. Culbertson, MD, added that vaccinations will make eye surgery practices busier — another point that eye care patients should keep in mind.   

“There will be pent-up demand for routine cataract surgery that has been deferred by patients during the pandemic,” said Culbertson, a professor at Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine in Miami, Florida. “We will need to address this need, but we want to get our entire staff vaccinated ASAP to feel comfortable working at full capacity.”

SEE RELATED: COVID-19 vaccines and vision

Some eye surgeries are already on the rise

In a 2020 article for All About Vision, Boxer Wachler noted the outpatient center where he performs cataract surgery saw a 32% reduction in procedures. But at least one kind of surgery has seen a jump in demand during the pandemic.

That surgery is called SMILE (short for SMall Incision Lenticule Extraction). This laser surgery to correct refractive errors is less invasive than LASIK. Both of these procedures reshape the cornea to clarify vision, but SMILE has a shorter recovery period after surgery. 

“By the next day, I was able to drive, wear eye makeup and rub my eyes,” said Melissa Nelson, a patient of Goel Vision, a practice in Baltimore, Maryland, in a report by CBS News. That practice has done the surgery on about 500 patients. 

“This has just been a game-changer for them,” said Sonny Goel, MD, medical director at Goel Vision. “They’ve been really impressed by how quick and easy the procedure is, how they’re back to work the next day and how they just didn’t think it would be that quick.”

The medical news aggregator, Healio, published an Ocular Surgery News report confirming a COVID-related rise in refractive surgeries.

For instance, Pacific Vision Institute in San Francisco, California, surveys its patients to get a sense of why they come in for eye care. Ella G. Faktorovich, MD, the institute’s founder, noted that the pandemic refactored people’s perception of the time available for eye surgeries. 

“They spend no time commuting,” Faktorovich told Ocular Surgery News. “They’re not traveling for work or for leisure as much anymore. Their time is flexible, and they have much more availability now to schedule appointments, consultations and procedures.” 

What are the safety protocols like for eye-surgery practices? 

Eye care practices have adopted stringent COVID-19 safety protocols. Screening methods are designed to keep COVID-positive people away from the office, but sometimes there’s no choice. After all, a patient who has COVID might still need eye surgery. 

For instance, the trade journal Retina Specialist documented a case in Washington state where a man with COVID-19 who had a detached retina needed an operation right away. 

“After extensive discussion with the perioperative staff, anesthesiologists and our surgical team, we developed a plan to keep all involved parties, including the ill patient, the other patients scheduled for eye surgery that day and all surgical staff, as safe as possible,” the authors of the Retina Specialist article wrote. 

That meant developing special protocols for protective clothing and preventing the patient from exhaling the virus into the operating area. The patient’s wife was also COVID-positive and had to be placed in a special room to avoid passing the virus within the office.  

A month later, the patient’s vision was on the road to recovery. COVID-19 posed inconveniences, but safe practices helped overcome them. 

“Overall, he is healing well after a safe and successful surgical intervention,” the authors wrote. 

If you’re curious about safety recommendations for eye surgeons, check out this list of guidelines from the American Academy of Ophthalmology

Do any kinds of eye surgery pose COVID risks? 

The complexity of the human eye and the persistence of viral infections require doctors and patients to watch out for potential risks. For instance, the journal JAMA Ophthalmology published a study in January 2021 exploring the threat of COVID infection via corneal transplants. 

Corneal transplant surgery can restore vision to people who suffer damage to their cornea, which is critical to eyesight. The cornea, a clear dome on the front of the eyeball, bends light waves to help them focus an image in the retina. The retina’s light-sensitive nerves then transmit visual information to the brain’s vision centers. 

The surge in COVID deaths produced a grim benefit — more corneas available for transplants. But there was a hitch noted in the JAMA Ophthalmology study. COVID-19 may persist in the corneas of those who died from the disease. 

The study recommended more research to figure out how much of the virus gets transmitted into the cornea. Ultimately, the study’s authors estimated that the risk of a corneal implant causing a COVID-19 infection is low. “Nevertheless, infection via a contaminated corneal graft cannot be fully excluded,” the authors concluded. 

This is just one more argument for getting vaccinated against COVID-19 as soon as the vaccine is available to you. And if you need eye surgery, talk to your eye doctor today.

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